Giant of Maryland LLC
Organization Active NPI Community/Retail Pharmacy · Reisterstown, MD
NPI 1104859453 · NPPES record last updated Oct 27, 2011
Key facts
- NPI
- 1104859453
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PO3032 (MD)
- Legal business name
- GIANT OF MARYLAND LLC
- Practice address
- 11604 Reisterstown Rd
Reisterstown, MD 21136-3702 - Phone
- (410) 526-1661
- Fax
- (410) 526-1690
- NPI assigned
- Jul 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Brad Dayton
- Title
- Director
- Phone
- (617) 770-8782
Corporate family (same tax ID) 23
Practitioners 4
-
Nathan Goldentayer, PHARMD
-
Jessica Hanyok, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D2130314 | Giant Pharmacy #322 | Certificate of waiver | May 7, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Giant Pharmacy #322 |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Ostomy Supplies|Urological Supplies|Surgical Dressings | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080916000625 | TX | Part B Supplier - Centralized Flu Biller | 7113914219 | This NPI is an additional NPI on the enrollment |
| O20100930096720 | MD | DME Supplier - Pharmacy |
7113914219 | Practice locations: Reisterstown, MD |
National Provider Directory
- Tax ID family
- Ahold USA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | PO3032 | MD | |
| Pharmacy | 333600000X | PO3032 | MD | |
| Community/Retail Pharmacy | 3336C0003X | PO3032 | MD | Yes |
Addresses
Primary practice location
11604 Reisterstown Rd
Reisterstown, MD 21136-3702
Mailing address
11604 Reisterstown Rd
Reisterstown, MD 21136-3702
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 365205000 | Medicaid | MD | |
| 2126399 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- GIANT PHARMACY 322
Other providers in Reisterstown, MD
- Esther Gbala
- Gentle Intensives, LLC
- Susan George
- Bella N Gershenzon
- Grace A Giannaras
- Gilead Counseling
- Glade Dental Practice LLC
- Nancy Glaser
- Global Health Services Inc-Omhc
- Global Health Services, Inc-PRP
All providers in Reisterstown, MD · Community/Retail Pharmacy in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.